Lakeshore Crest,LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL8496H Issued in AZ

Legal business name

LAKESHORE CREST,LLC

Practice address

19535 N 55TH Dr
Glendale, AZ 85308-6805

Phone

(623) 376-6469

NPI assigned

Jun 27, 2011

Last updated

Mar 12, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mariafe Santos Castro

Title

Manager

Phone

(480) 518-1969

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331510400000",
    "number": "1568758795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19535 N 55TH DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086805",
            "telephone_number": "623-376-6469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19535 N 55TH DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086805",
            "telephone_number": "623-376-6469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE CREST,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-27",
        "last_updated": "2012-03-12",
        "status": "A",
        "authorized_official_last_name": "CASTRO",
        "authorized_official_first_name": "MARIAFE",
        "authorized_official_middle_name": "SANTOS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "480-518-1969"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL8496H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "629718",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.